Provider Demographics
NPI:1326008137
Name:BOYD, JAMISON T (OD)
Entity Type:Individual
Prefix:
First Name:JAMISON
Middle Name:T
Last Name:BOYD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:902 S COURT ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:TUSCOLA
Mailing Address - State:IL
Mailing Address - Zip Code:61953
Mailing Address - Country:US
Mailing Address - Phone:217-253-2220
Mailing Address - Fax:217-253-2292
Practice Address - Street 1:902 S COURT ST
Practice Address - Street 2:SUITE #1
Practice Address - City:TUSCOLA
Practice Address - State:IL
Practice Address - Zip Code:61953
Practice Address - Country:US
Practice Address - Phone:217-235-2220
Practice Address - Fax:217-253-2292
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05815176OtherBLUE CROSS & BLUE SHIELD
IL410047783OtherMEDICARE RR
IL046008823Medicaid
IL352450Medicare Oscar/Certification
IL1116720001Medicare NSC
ILU58272Medicare UPIN
IL05815176OtherBLUE CROSS & BLUE SHIELD